FAYETTEVILLE — Veterans got cold food, improper medicines and lacked sanitary care at the Fayetteville Veterans Home, according to a series of inspections by state regulators.
In all, state inspectors noted more than two dozen violations of health care laws in a series of reviews at the home this year.
A patient-rights advocate said the report was the worst she has seen in years, while administrators said the problems were minor and all have been corrected.
A survey team from the Arkansas Office of Long Term Care observed 22 violations in a March 19 visit, with problems ranging from medication errors, sanitary conditions, inaccurate record keeping and cold or inedible food. A follow-up visit in June uncovered five more medication-error and sanitary issues.
"This survey appalled me worse than any I've seen in at least 15 years," said Martha Deaver of Arkansans Advocating Nursing Home Reform, a patient-rights nonprofit organization. "The finding of a nearly 27 percent medication error rate is staggering. It's simply unheard of."
Federal law requires an error rate of 5 percent or less. In some cases, patients were given pain medication that doctors had ordered discontinued, more insulin than they needed or medication without food or drinks as required, according to the report.
Some of the violations, however, aren't nearly what they might seem at first glance, said Nadine Huddleston, the home's administrator. One of the cited medicine errors was as simple as a medicated drop missing the patient's eye, a problem immediately fixed by applying a second drop correctly, Huddleston said.
AT A GLANCE
Top Violations
The top 10 types of violations of health care laws in Arkansas nursing homes:
• Accidents
• Bedsores
• Infection control
• Quality of care
• Medication error rates above 5 percent
• Food storage, prep and serving
• Significant medical errors
• Services by qualified staff
• Necessary services given to patients
• Urinary incontinence
Source: Arkansas Foundation for Medical Care
Other errors included the wrong type of aspirin, drugs that were stored or labeled improperly and administering drugs or oxygen therapy without the necessary doctor's orders or other paperwork on the patient's medical charts.
The home was also cited for serving cold and poor-quality food, ignoring supplemental-nutrition menus and patient meal preferences and serving shakes that included sugar to diabetic patients. The food is prepared by a third-party contractor. The contractor also provides food to the medical school campus, prepared in a kitchen that's downstairs from the veterans home.
Home administrators have worked with the food contractor to improve service, implementing patient-preference and food tray forms, monitoring temperatures with digital thermometers and improving sanitary problems, Huddleston said. The contractor also performed background checks and state registry approvals for its employees, which hadn't been completed and for which the home was cited.
"To someone reading this report out of the blue, these things sound shocking, yes. But there are many variables to each of these things, and the answer is monitoring and observation. That, and constantly retraining people, Huddleston said. "That's what we outlined and implemented in our plan for correction, which is how all facilities have to respond to this type of audit."
The 22 violations found in March and five in May are more than twice the average for nursing homes in the state, which average about 12 per year, according to statistics from the Office of Long Term Care.
The report is "bad, but not awful. It certainly shows they need to improve," said Mike Hathorn, president of Pinnacle Healthcare, which runs Fianna Hills Nursing Home in Fort Smith, and has operated as many as 14 homes in Arkansas and Missouri in the past.
"Some of these are relatively minor things, simple to correct and unlikely to happen again. Others are a bigger deal" he said.
State surveys almost always turn up some type of deficiencies at any given facility, he said.
"Just getting a citation doesn't mean you're looking at a bad home. You've got to look at the specifics," he said.
Three percent of the 234 nursing homes throughout the state went without a single citation in 2010, according to figures from the long-term care office.
Investigators also went to the veterans home in April to investigate a complaint of possible abuse after a resident developed a bruised arm for unknown reasons. The home was cited for failing to determine the origin of the bruise, which Huddleston said was noticed after the patient left the facility for a day out.
"We couldn't tell them because we really didn't know, and so they cited us for not being able to provide a reason," she said.
Similar surveys in 2009 and 2010 noted fewer deficiencies, with four found in 2009 and seven in 2010. The home flunked a federal inspection for fire safety in 2010, which Huddleston said was construction-related problems and unknown to officials until inspectors found them.
The fire inspection was the only time federal-level inspectors have visited the home since 2009, said Brenda Styles, program director for the state Office of Long Term Care. State teams survey nursing homes annually, while federal inspections are random, with only a percentage of nursing homes nationally surveyed each year.
One thing that isn't happening is veterans complaining, said Steve Gray, veterans affairs liaison for Sen. John Boozman, R-Ark. Gray visits the facility about once a month as part of a program to present forgotten decorations to veterans.
"In talking to those folks, they seem to love the facility. Nobody's ever approached me with any problems or complaints, and they know who I am and how I'd be able to help," Gray said. "I've only eaten cake at the presentation parties, so I can't speak to the quality of the food, but it seems like a good experience for our veterans."
Residents, veterans and families haven't given much feedback, good or bad, to Jake Greeling, commander of the American Legion post in Bella Vista.
"I've been there quite a few times visiting folks, and I've been to quite a few other nursing homes throughout the nation too," Greeling said. "It seems like no matter where you go, the food isn't great, their hair is never combed and their clothes are rumpled. As for the VA home in Fayetteville, nobody's come to me saying it's good, bad or indifferent. In my view, it's as good as any other nursing home I've been in, but none of them are great. It's a sad state of affairs whenever somebody has to go to any nursing home."
The home opened in 2006 on two renovated floors of the former Washington Regional Medical Center, at the corner of College and Township in Fayetteville. It's one of two nursing homes in Arkansas dedicated to veterans, and the only one run by the Arkansas Department of Veterans Affairs. The 108-bed home rents its space from the University of Arkansas for Medical Sciences, which secured a 99-year lease to the building in 2005 for $1.
The hospital also houses a satellite UAMS campus, several clinics and a private long-term intensive care hospital unit.
The home is rated two stars out of a possible five by the nursing home comparison site hosted by Medicare. Annual inspection surveys are one of the components in the rating system. The home scored only one star in the inspection portion of the rating.
"Two stars isn't a great rating, but the rating system isn't all that good to begin with," Hathorn said. "Not to take away from homes with four or five stars; they're great places. But getting hit hard on a survey can really drop a home's rating. Even if it's something that can be fixed immediately, you have to live with that survey and that rating until the next year and the next survey."
There are multiple inspection teams throughout Arkansas, and the same inspectors don't always visit the same facilities in successive years. A different team may look at things differently, Huddleston said.
Claims of more citations from different teams are both common and false, said Deaver, the patient advocate.
"That is the number one excuse of the nursing home industry. It's what they'll say every time," she said.
The teams appear equal and consistent, Hathorn said.
"If they have a reason to think you're not acting in the best interests of your residents, they might take a harder look, but I've been very satisfied over the years with the consistency and the thoroughness of the inspectors, even when it means we get fined," Hathorn said. "They're helping us make sure our patients have the best care possible."
The correction plans submitted by the home have already been approved and implemented, Huddleston said.
Most of the plans include training on various topics to reinforce proper procedures for nurses and other caregivers, along with periodic checks by administrators and directors to ensure the standards continue to be followed, according to documents. Food preparation and heating have been modified, and all improperly labeled and expired medications were destroyed and replaced with fresh ones.
The home expects to do better on the next survey, which will happen some time in early 2012, Huddleston said.
"We had some minor things, and we got them addressed, so I'm confident we're in good shape," she said.
While a perfect score isn't expected of any nursing home, one dedicated to veterans needs to set a high standard, Deaver said.
“That’s especially true when they’re in a nursing home setting. They sacrificed for us, and they wouldn’t be there if they didn’t need 24/7 care. They deserve the best.”